Chronic Pain

Question 1

International Association on the Study of Pain defines it as:

Answer 1

“An unpleasant sensory and emotional experience which follows actual or potential tissue damage or is described in terms of such damage”

Question 2

Physical pain is equivalent to

Answer 2

Emotional pain

Question 3

More specific definition for pain regarding neural signature

Answer 3

• A multiple system output that is activated by an individual’s specific neural signature
• This neural signature is activated whenever the person perceives a threat

Question 4

Which areas are highly active with chronic pain and depression?

Answer 4

Emotion-related brain areas

Question 5

Because emotion-related brain areas are so active with chronic pain and depression, what does this mean?

Answer 5

Something other than tissue damage is causing pain

Question 6

Pain is the end result of

Answer 6

• Central processing of sensory stimuli

- Change persists in the brain/SC even though damage may no longer be present

Question 7

Chronic pain is often described as pain that:

Answer 7

• persists longer than 3 months
• persists after the usual time for tissue healing
• occurs in the absence of obvious nociception

Question 8

3 types of acute pain

Answer 8

• nociceptive
• inflammatory
• neuropathic

Question 9

Nociceptive pain

Answer 9

noxious stimulus causes pain

Question 10

Inflammatory pain

Answer 10

Pain that comes from inflammation

Question 11

Neuropathic pain

Answer 11

Damage to CNS/PNS

Question 12

Which types of acute pain typically contribute to pain syndromes?

Answer 12

All types

Question 13

The brain controls pain through these systems

Answer 13

• facilitatory system “accelerator”

- inhibitory system “brake”

Question 14

facilitatory system for brain’s control of pain

Answer 14

Allow to feel/respond to pain very quickly (NORMAL)

Question 15

facilitatory system for brain’s control of pain: What happens with chronic pain?

Answer 15

• Facilitatory system works better than the inhibitory system
• May have some genetic component

Question 16

Inhibitory system for brain’s control of pain: What happens normally, and how is this changed with someone who has chronic pain?

Answer 16

• May have some pain, but not enough to move out of the way immediately (requires temporal summation)
• malfunctioning in people with chronic pain

Question 17

Brain processing of pain

Answer 17

• entire brain is active

- no specific “pain areas”

Question 18

What is a pain map?

Answer 18

• brain has a particular pain map that occurs regardless of specific tissues injured
• brain knows the back hurts, but doesn’t know which specific structures are involved (i.e. skin, facets, disc)

Question 19

What is smudging and when does it happen?

Answer 19

• Smudging occurs in the cortex with distributed pain maps
• Areas within SSC no longer have distinct lines between areas
• Get more diffuse pain in different areas due to PHYSICAL CHANGES IN THE BRAIN!

Question 20

How is a representation of pain often caused in the brain?

Answer 20

• anticipation of pain or giving the illusion of pain

- distraction or anxiety can contribute

Question 21

How do the areas of the brain that use emotional pain compare to those that are associated with physical pain?

Answer 21

• Same areas

- This is why we use a bio-psychosocial approach to pain